Ezekiel Emanuel Gets It Wrong on Cost Control

Liberals don’t care about controlling healthcare costs.   Or so we just learned from Dr. Ezekiel Emanuel, a well-known oncologist,  former presidential advisor on health care policy, now employed as vice provost and professor at the University of Pennsylvania, and still the brother of Rahm, a fellow Obama White House alum who now rules Chicago.

Emanuel (the doctor, not the mayor) made this blatantly false accusation in a Jan 22  New York Times opinion piece.  In his article, entitled “What We Give Up for Health Care,” he stitches together a complete straw man – in the form of “liberals” (who knew America still had any?) who are so concerned about securing universal health coverage that they fail to grapple with the problem of medical cost inflation and thus end up depriving other government programs of needed funding.

According to the good doctor, the aforementioned “liberals” view any discussion or promotion of health care cost containment as just “ a cover for heartless conservatives who care only about cutting benefits and not about helping people in need.”  “Liberals,” he opines, “are wrong to ignore costs.”

This political smear may have attracted the  attention of  The NYT’s opinion page editors, but Emanuel’s claim is clearly as specious as it is sanctimonious.

Which liberals is Emanuel referring to?  The ones who have been fighting to replace our private insurer and employer dominated healthcare system–that is indeed the most costly in the world–with a single payer plan that would save many billions of dollars? (Sadly, such efforts have never been supported by either Emanuel brother, before, during, or after their influential White House years).

Has Dr. Emanuel forgotten about all those liberals (and other left-of-center health reform advocates) who have correctly targeted Big Pharma, medical equipment manufacturers,  the insurance industry, for-profit hospital chains, and more than a few overpaid medical specialists as major cost escalators in our current system?

In real life, liberals and other progressive healthcare reform advocates are the very people who have been criticizing, for many years, the waste of precious healthcare dollars on unnecessary medical plan marketing and billing costs, not to mention the extravagant salaries and benefit packages bestowed upon hospital administrators and private insurance company executives.

Liberal and radical whistle-blowers have – over and over again — exposed the way huge drug industry profits have been generated from the systematic bilking of the sick, the government, and private insurers, leading to the highest pharmaceutical costs in the industrialized world. These same critics of the status quo have catalogued the cost of under-regulated pill peddling –in the form of direct to consumer advertising, bribing doctors to prescribe off label uses of new drugs,and  producing phony studies to validate and promote FDA approval of these medications (to name only a few costly and unhealthy Big Pharma practices).

Those to the left of Dr. Emmanuel have long noted that American physicians earn much higher salaries than their European or Canadian counterparts, who operate in national health care systems. MD compensation in the U.S.helps  boost our overall health care spending because it is far beyond levels necessary for doctors to pay for their currently very costly medical education and then open,  join, or maintain a medical practice. In any rational system, of the sort most liberals support, medical education and medical practice overhead costs would be socialized.

Finally, we know that Emmanuel’s brother is no fan of unions. But is he himself unaware that one of our largest liberal institutions —  organized labor –spends a huge amount of time trying to help unionized employers save money on health care costs?  These “cost-containment” efforts are, for better or worse (depending on the union involved) a very big part of private and public sector collective bargaining everywhere in the U.S.

In reality, it is not liberals, but conservatives, who have consistently thwarted any effort at real cost-containment – other than various forms of benefit reduction and/or cost-shifting.  It was the well-known non-liberal, President George W. Bush, and his bi-partisan allies in Congress who made sure that the federal government would not be able to negotiate better prices with the pharmaceutical industry when Medicare drug coverage was expanded during his administration.

Conservative legislators, before and since, have always been against any cost-effective regulation of the insurance and hospital industries.  Instead, Republicans in Congress and presidential candidates like Mitt Romney are now focusing their political energies on attacking one of the best publicly-funded healthcare delivery systems in the U.S.–operated by the Veterans Administration.

Can Ezekiel Emanuel point to any single conservative proposal to curb medical cost inflation by addressing the real cost-escalators in the system – insurance company profit and overhead, out of control pharmaceutical costs, and/or costs incurred for unnecessary, futile medical treatment.

It’s an insult to people who have been struggling for real healthcare reform for decades to suggest that American liberals are oblivious to the need for healthcare cost containment. If our health care system was fundamentally reformed, U.S. healthcare costs might finally be brought in line with the rest of the industrialized world and the money saved would indeed be freed up for housing, education, childcare, infrastructure reform, etc.

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